Midlife Women's Menopausal Transition Symptom Experience and Access to Medical and Integrative Health Care: Informing the Development of MENOGAP.

Background: Individuals with a uterus experience menopause, the cessation of menses, on average at age 51 years in the United States. While menopause is a natural occurrence for most, over 85% of women experience multiple interfering symptoms. Menopausal women face health disparities, including a lack of access to high-quality healthcare and greater disparities are experienced by women who are black, indigenous, and people of color. Some women are turning away from hormone therapy, and some seek integrative health interventions. Objective: Some menopausal women who seek healthcare do not receive it as they lack access to medical and integrative healthcare providers. A potential solution to this problem is a medical group visit (MGV), during which a provider sees multiple patients at once. The aims of this study were to gather women's opinions about the menopause, provider access, and conventional and integrative health interventions for later use to develop a menopause MGV. Methods: We conducted a Community Engagement Session and a Return of Results (RoR) with midlife women to learn about their menopause experiences, barriers and facilitators to accessing health providers, and their interest in and suggestions for designing a future integrative MGV (IMGV). Thematic qualitative research methods were used to summarize session results. Results: Nine women participated in the Session and six attended the RoR. Participants were well-educated and diverse in race and ethnicity. Themes included: an interest in this topic; unfamiliar medical terms; relevant social factors; desired whole person care; interest in integrative health; barriers and facilitators to accessing healthcare. The group expressed interest in ongoing participation in the future process of adapting an IMGV, naming it MENOGAP. Conclusion: These findings highlight the importance of stakeholder engagement before designing and implementing MENOGAP and the great need among midlife women for education about the menopausal transition, integrative self-care, and healthcare.

Demonstration of anaerobic stabilization of black water in accumulation systems under tropical conditions.

The anaerobic digestion of "human waste" was studied at Mlalakuwa residential settlement in Dar-es-Salaam, Tanzania at ambient tropical temperatures (24-31 degrees C). This settlement experiences a high water table with flooding during the rainy season, resulting in a very costly emptying of the latrines once per month. To improve the situation, two plastic tanks (while one is in use, the other one is on stand-by) of 3000 l capacity each, named as Improved Pit-Latrines Without Urine Separation (IMPLWUS), were used as latrine pits. They received faeces+urine+wash water; basically, an accumulation system. Septic tank seed sludge was used. The dissolved chemical oxygen demand (COD(dis)) remaining when the reactor was closed after 380 days was about 8 g COD/l, volatile fatty acids were 100 mg COD/l and total ammonium nitrogen was about 2.8 g N/l, implying the possibility of methanogenesis inhibition. Stability results indicated a need for more degradation time after reactor closure. Estimated biogas production from wastewater generated by 10 people was 544 g COD-CH(4)/day, not enough for cooking purposes.

Effect of temperature on anaerobic treatment of black water in UASB-septic tank systems.

The effect of northern European seasonal temperature changes and low temperature on the performance of upflow anaerobic sludge blanket (UASB)-septic tanks treating black water was studied. Three UASB-septic tanks were monitored with different operational parameters and at different temperatures. The results indicated the feasibility of the UASB-septic tank for (pre)treatment of black water at low temperatures with respect to removal of suspended solids and dissolved organic material. Inoculum sludge had little effect on COD(ss) removal, though in the start-up phase some poorly adapted inoculum disintegrated and washed out, thus requiring consideration when designing the process. Removal of COD(dis) was at first negative, but improved as the sludge adapted to low temperature. The UASB-septic tank alone did not comply with Finnish or Dutch treatment requirements and should therefore be considered mainly as a pre-treatment method. However, measuring the requirements as mgCOD l(-1) may not always be the best method, as the volume of the effluent discharged is also an important factor in the final amount of COD entering the receiving water bodies.

Excreta disposal in Dar-es-Salaam.

The sociocultural and socioeconomic situation of sanitation in Dar-es-Salaam (Dsm), Tanzania, was studied with explicit emphasis on pit-latrines. Without considering the sociocultural conditions, the so-called best solution might not be the right one. Therefore, in order to achieve the intended goal, a literature review, a questionnaire survey, and personal visits to the chosen study areas were done. In total, 207 household questionnaires were filled in 16 areas of the city. Interviewers did house-to-house visits and questionnaires were filled out on the spot. Results indicated that the city population is about 3.8 million at present, with over 80% of the dwellers using pit-latrines; some 3% use septic tanks with soakage pits, about 6% are connected to the sewerage system, and 1% have no excreta disposal facility. Difficulties faced include dismal budget allocations, fragmentation of sanitation activities among subsectors, lack of or poor sanitation record keeping, unsatisfactory machinery for septic tank and pit-latrine emptying, lack of a clear policy on pit-latrine handling and, in competition for resources, low priority is accorded to an excreta disposal system among the people. City residents will continue to use the pit-latrines for a long time to come. Reusing the fecal sludge is not known by most city dwellers and is influenced by sociocultural habits. To prevent groundwater pollution and to recover useful products in human excreta and urine, ecological sanitation toilets and anaerobic digesters offer a good option.